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Clinical Benefits of Joint Mobilization on Ankle Sprains: A Systematic Review and Meta-Analysis

Published:September 04, 2017DOI:https://doi.org/10.1016/j.apmr.2017.07.019

      Abstract

      Objective

      To assess the clinical benefits of joint mobilization for ankle sprains.

      Data Sources

      MEDLINE, MEDLINE In-Process, Embase, AMED, PsycINFO, CINAHL, Cochrane Library, PEDro, Scopus, SPORTDiscus, and Dissertations and Theses were searched from inception to June 2017.

      Study Selection

      Studies investigating humans with grade I or II lateral or medial sprains of the ankle in any pathologic state from acute to chronic, who had been treated with joint mobilization were considered for inclusion. Any conservative intervention was considered as a comparator. Commonly reported clinical outcomes were considered such as ankle range of movement, pain, and function. After screening of 1530 abstracts, 56 studies were selected for full-text screening, and 23 were eligible for inclusion. Eleven studies on chronic sprains reported sufficient data for meta-analysis.

      Data Extraction

      Data were extracted using the participants, interventions, comparison, outcomes, and study design approach. Clinically relevant outcomes (dorsiflexion range, proprioception, balance, function, pain threshold, pain intensity) were assessed at immediate, short-term, and long-term follow-up points.

      Data Synthesis

      Methodological quality was assessed independently by 2 reviewers, and most studies were found to be of moderate quality, with no studies rated as poor. Meta-analysis revealed significant immediate benefits of joint mobilization compared with comparators on improving posteromedial dynamic balance (P=.0004), but not for improving dorsiflexion range (P=.16), static balance (P=.96), or pain intensity (P=.45). Joint mobilization was beneficial in the short-term for improving weight-bearing dorsiflexion range (P=.003) compared with a control.

      Conclusions

      Joint mobilization appears to be beneficial for improving dynamic balance immediately after application, and dorsiflexion range in the short-term. Long-term benefits have not been adequately investigated.

      Keywords

      List of abbreviations:

      CI (confidence interval), DFROM (dorsiflexion range of motion), MCID (minimal clinically important difference), MD (mean difference), MWM (mobilization with movement), RICE (rest, ice, compression, and elevation), ROM (range of motion), SEBT (star excursion balance test), SMD (standardized mean difference)
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